Treating the Problem Prior to Implantation
Treatment of recurrent pregnancy loss before implantation is dependent on the cause. If the cause of the loss lies within the embryo itself, the options for treatment include:
Treatment of problems within the uterine environment varies with the cause. Anatomic abnormalities are removed surgically. Hormonal therapy is usually prescribed with assisted reproductive technology procedures. Immunologic problems are treated with immunotherapy. Therapies that have been shown to be effective in the treatment of recurrent pregnancy loss before implantation at the Reproductive Medicine Institute, serving the greater Chicago area, include:
- Intravenous Immunoglobulin (IVIg) – the only medication that has been shown in randomized placebo controlled trials to be effective in the treatment of implantation failure. IVIg was shown to benefit those women experiencing implantation failure after IVF/ET who were good embryo producers (fertilized at least 50 percent of eggs retrieved and generated at least 3 embryos for transfer). Implantation rates increased from 7 percent with placebo to 18 percent with IVIg in one randomized trial and from 9 percent to 40 percent in another randomized trial. IVIg is usually administered at least 6 to 7 days prior to embryo transfer. The usual dosage for implantation failure is 40mg prior to embryo transfer and 40mg after the first positive pregnancy test. In some instances it may be necessary to repeat IVIg infusions every three to four weeks until the end of the first trimester of pregnancy. Overall, the pregnancy rate per cycle in women with a history of previous implantation failure after IVF/ET who are treated with IVIg is 50 percent and live birth rate is 70 percent.
- Intralipid – Evidence from both animal and human studies suggest that intralipid administered intravenously may enhance implantation. Intralipid is a 20 percent intravenous fat emulsion used routinely as a source of fat and calories for patients requiring parental nutrition. It is composed of 10 percent soybean oil, 1.2 percent egg yolk phospholipids, 2.25 percent gylcerine and water. Intralipid stimulated the immune system to remove “danger signals” that can lead to pregnancy loss. The appeal of Intralipid lies in the fact that it is relatively inexpensive and is not a blood product.
- Phosphodiesterase Inhibitors – responsible for enzymatic degradation of molecules within the cells involved in generating energy for the cell to function. They have anti-inflammatory effects. Two phosphodiesterase inhibitors—Sildenfil (Viagra) and Pentoxiphylline (Trental) have been shown to increase blood flow to the uterus. Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. Significant improvement of the thickness of the uterine lining in about 70 percent of women treated. Successful pregnancy resulted in 42 percent of women who had previously experienced repeated IVF failures and who responded to the Viagra. Similar results were obtained when Trental was used in 400mg twice a day doses alone with vitamin E to treat women experiencing implantation failure associated with thin endometrium and elevated uterine NK cells. Animal studies have demonstrated that pentoxifylline prevents miscarriages in abortion-prone mice. Efficacy of pentoxifylline for treatment of recurrent pregnancy loss in human beings remains to be established.
Learn More before Implantation
It is important to understand all your options for treatment of recurrent pregnancy loss before implantation. At our Chicago-area clinics, our team strives to educate our patients on their options prior to any treatment. Please contact us to schedule a personal consultation with one of our fertility specialists.